Independent Review Rights
In addition to your rights to file a complaint or grievance concerning your claim or benefit denial, you may also be entitled to an independent review by medical professionals who have no connection to us to address your concerns about this claim. You must first complete the internal grievance process before you can initiate an independent review. However, you do not need to complete the grievance process if you need immediate medical treatment and the time period for completing the grievance process will cause a delay that could jeopardize your life or health or we agree with you that it is in everyone’s best interest to proceed with your concern directly to independent review.
Please refer to the Health Care Insurer Appeals Process Amendment Rider, N-00162WI(06/02), included with your Certificate of Coverage for more information on your grievance and independent review rights. The rider contains valuable information regarding the independent review process. A listing of certified independent review organizations may be obtained by calling our office at 1 800-821-7303. Additional information may be obtained from the Office of the Commissioner (OCI) at 1 608-266-0103 (Madison, WI) or 1-800-236-8517 (outside Madison, WI) or at the OCI website at OCI Website.